What are the responsibilities and job description for the Network Provider Enrollment Specialist position at Exceed Healthcare?
We deliver innovative healthcare solutions using the highest quality, cost effective, data driven practices
Exceed Healthcare
Network Provider Enrollment Specialist
About us :
Exceed Healthcare is a premier management services organization (MSO) that provides an extensive range of first-class administrative solutions to healthcare providers, enabling them to focus on delivering exceptional patient care and optimizing clinical outcomes. Over the past 10 years, we have grown to be one of the fastest growing management services organizations in our industry.
Summary : Responsible for all aspects of the credentialing, re credentialing, and privileging processes for all medical providers who provide patient care as clients of Exceed Healthcare. Responsible for ensuring providers are credentialed, appointed, and privileged with health plans, hospitals and patient care facilities. Maintain up-to-date data for each provider in credentialing databases and online systems; ensure timely renewal of licenses and certifications.
Job Duties :
As a Network Provider Enrollment Specialist for Exceed Healthcare LLC, Your job duties include, but are not limited to, the following :
Payer Credentialing
- Performs follow-up with insurance payers via phone, email or website to resolve payer credentialing issues.
- Works closely with external payer credentialing vendors on notification of a provider's start, welcome packets, provider documentation and ensuring the provider is in all systems.
- Manage the completion and submission of provider enrollment applications.
- Perform tracking and follow-up to ensure provider numbers are established and linked to the appropriate group entity in a timely manner.
- Understand specific application requirements for each payer including prerequisites, forms required, form completion requirements, supporting documentation (DEA, CV, etc.) and regulations.
- Maintain documentation and reporting regarding provider enrollments in process.
- Retain records related to completed payer credentialing applications.
- Update insurance programs with location change information within 90 days of change.
- Ensure accounts, PTAN, and other identifying numbers remain active.
- Diligent follow up with insurance companies throughout the application process.
Additional Responsibilities :
1. Maintain confidentiality of provider information
2. Provides credentialing and privileging verifications
3. Performs other duties and special projects as assigned.
Exceed offers :
PTO Package for all non-clinical full time employees.
Training
Health, Dental, Vision benefits
401K
Growth Opportunities
We are an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or veteran status.